1. Field of the Invention
The present invention relates generally to surgical implants, and more particularly to surgical implants and methods for re-positioning and/or lifting a patient's eye brow.
2. Background Discussion
Repositioning or lifting of the eyebrow is a surgical procedure typically performed to address tissue laxity or “sagging” that occurs as a result of trauma or injury, or more commonly as part of the typical aging process. In a balanced, youthful female face, the eyebrow is lower medially (toward the center of the face), and higher laterally, with a variable arch in between. In a male face, there is no distinct difference between medial and lateral aspects of the brow—the entire brow is positioned horizontally. Early signs of brow and periorbital aging include brow ptosis with a lowering of the medial and lateral hair-bearing brow and development of a vertical glabellar and horizontal forehead lines. These changes can result in alterations of facial expressions, exhibiting a tired, concerned, or even angry look. Often, there is a real or apparent excess of skin on the upper eyelid.
A variety of techniques have been used to reposition and/or reshape the brow. Most involve mobilization, repositioning, and fixation of the brow with modifications to the forehead musculature. The brow lift techniques are typically characterized as coronal, endoscopic, or limited-incision foreheadplasty techniques. The open standard coronal brow lift was for many years the only option for forehead and brow rejuvenation, and it remains today the gold standard against which other newer, less invasive techniques are measured.
In the coronal technique, a relatively long incision (7-9 cm) is typically made along the same direction as, but posterior to the frontal hairline. Alternatively the incision may be placed anterior to the frontal hairline if it is desired to shorten a long forehead. Following known dissection techniques, the forehead flap is then elevated, excess skin and tissue excised, and the wound subsequently closed. Although the technique is relatively simplistic and has wide exposure, disadvantages include the long scar, and long-term, usually permanent changes in scalp sensation due to nerve damage.
In the endoscopic technique that was introduced in the 1970's, one to three vertical frontal scalp incisions and two bilateral temporal scalp incisions are made. Through these incisions, the surgeon dissects certain portions of the tissue to transpose the forehead. The repositioned tissue is typically fixed via sutures to bone screws or the like placed in the cortical bone. This technique requires limited incisions, but requires expensive endoscopic equipment and skill in its use.
The limited-incision foreheadplasty technique is focused on the correction of the lateral portion of the brow. Two bilateral temporal scalp incisions and two upper blepharoplasty incisions are made, through which the muscles and tissue are repositioned. Although incisions are limited and endoscopic equipment is not needed, there is less visualization for dissection than with either the coronal incision or the endoscopic techniques, making familiarity with local anatomy important and requiring a skilled surgeon.
In addition to the fixation devices motioned above, devices such as barbed sutures, mesh and tined devices have also been known to be used in brow lift procedures. At least one surgeon is known to have utilized a planar, implantable polypropylene mesh in brow lift procedures. The mesh 100 is approximately 3 cm in width, and is placed under the galeal plane above the periosteum, and extends from just above the brow and up the forehead as shown in FIGS. 1 and 1a. Tissue ingrowth occurs, eventually causing the implanted mesh to serve as an artificial suspensory aponeurosis that provides stable fixation to maintain the elevated position of the eyebrow. Due to its placement under the galeal plane above the periosteum, this implant remains palpable under the forehead skin. Further, this implant and procedure does not allow a gradient brow elevation where the level of brow elevation increases from the medial toward the lateral side. Gradient brow elevation is advantageous in providing a desired, authentic result in large number of female patients.
Accordingly, there is a need for an improved implant and method for brow lift procedures.